Inhaler v Oral Steroids (Prednisolone etc)

[Matman]

Hi

This is NOT medical advice but (rightly or wrongly) something 'I do' - to delay / avoid taking Oral Steroids when I get more wheezy (but before I get 'too' poorly) - is increase my 'Inhaled' Steroids for a week or so.

The thinking behind this is that the 'Inhaled' Steroids are delivered in much smaller dosage than Oral Steroids, and therefore are likely to have far less 'long-term' side-effects than (too often) reaching for Steroids in Pill Form ( 'or' increasing the Dosage of any Oral Steroid Course I might already be on). An additional benefit, is that - unlike Oral Steroids - 'Inhaled' Steroids are delivered direct to the airways (where symptoms are occurring).

While, I'm by no means sure that you GP / Consultant would support this short-term tactic for trying to prevent the need to take / increase use of Oral Steroids, you could (when next speaking to your Medical Adviser) ask their view on this.

For sure, the amount of Steroid that will impact me 'systemically' (where it can cause longer-term risks) if my 'Inhaled' Steroid Dose is temporarily increased a little, will be much less than if I took - even a 'meagre' 5mg - of Oral Steroid.

An 'Inhaled' Steroid Increase 'might just' ward off a worsening attack sufficiently for me to start improving, thereby sometimes avoiding the need to turn to (or increase) Oral Steroids.

If you're already on (or very close to) the 'maximum' dose of 'Inhaled' Steroid allowed, then the tactic I'm discussing 'might' not be appropriate. (I say, 'might' not, because it's, perhaps, debatable - even if 'already' on the 'maximum' inhaled steroid dose -whether increasing Dosage for the 'short' period I referenced above, would be 'particularly risky'. Plus, any 'additional risk' from increasing 'Inhaled' Steroids needs to be compared to the 'risk' incurred by increasing 'Oral' Steroid Use.

If you're using a Duel Inhaler (like me) to deliver 'Inhaled' Steroids, then because Duel Inhalers contain not just an Inhaled Steroid but also a 'second' drug - most typically a LABA (Long Acting Beta Agonist) similar to the Short Acting Beta Agonist (SABA) in Common Rescue Inhalers like Ventolin (though bit less potent and longer lasting) - it's necessary to take into account that, by doing 'what i do', you'd be increasing not only your Inhaled Steroid Dose, but also your LABA Dose. However, quite a number of Medics seem to be encouraging the 'increased use' of Duel Inhalers (which include LABAs) as an 'alternative' to using a Traditional Rescue Inhaler such as Ventolin (or before turning to Rescue Inhaler Use). The message this seems to deliver is that - if 'more poorly' than normal - it's OK to increase your Inhaled Steroid + LABA, by way of 'extra' use of your Duel Inhaler, at least for a while. (Also, I gather, the LABA helps facilitate better utilisation of the inhaled steroid).

If you're on a Triple Inhaler, things get more complicated, so (whatever Steroid Delivering Inhaler you use, Single, Duel or Triple) check with you Medical Adviser before adopting my tactic.

This was meant to be a brief Post, so apologies for the fact that it's rambled on for longer than intended.

Thanks in advance for any Comments / Thoughts (in case I don't manage to respond in some cases).

[emmasue]

My only point is that if I do not increase my oral steroid intake when I first have a flare up, I have a worse time and end up needing more steroids. If I increase my oral steroid intake at the beginning of a flare up, I can tapper off relatively quickly and I don't end up ill. Surely it is better to deal with an exacerbation quickly rather than let it fester and end up as a chest infection. Just an idea.

[Matman in reply to emmasue]

Thanks. Guess it's not a 'one size' fits all situation (solution) and that either approach may be appropriate. I agree that exacerbations (and there ability to reduce lung function still further) is a 'prime' consideration, but in some ways it's a balance and I don't want to be on a dozen or more Oral Steroid Bursts a Year (my current target is - if possible - to have no more than 3 Bursts in 2018. (As I'm feeling rough right now, I'm not entirely optimistic, but am practising what I've said combined with lots of rest, selective supplements and very good quality food / drink).

[emmasue in reply to Matman]

You are right in that every asthma patient is different. I do worry about having to be on a daily steroid tablet, but I went through about 6 years of having chest infections 4 or 5 times a year and being hospitalised twice. I would rather not go through those infections again. I was so ill that I was coughing up blood, I couldn't even get up at times. I've got two kids to care for and it I was just constantly ill. Now, this winter, so far, I've not had a chest infection or a cold even. It makes such a difference.

[elanaoali]

As others have said one size doesn't fit all levels For those who have the opportunity to double there inhaler then this is the right course of action. However for people like me who are on the highest dose of fostair next inhaler 200 and flixoideEd 250 there is no where to go from there. My plan states that if I feel worsen i.e my symptoms mean I am reaching for my ventolin more than 3 times in one week then contact my GP and let them know I started taking my rescue steroids. 40 mg for 7 days.

As you can see from my latest post I ignored my drop in peak flow 350/500 for a few days and ended up with an asthma attack.

We may not like taking a course of prednisone but it is an essential that we do when faced with a suitation like mine.

However I fully appreciate the time you have taken to write this post. It does give us something to think about.

[mmmp4cj2]

There is some evidence that quadrupling the ICS can avoid an exacerbation but for most with ICS/LABA certainly those on the higher dose end this would put the LABA dose up too high. Personally if I take 500mg fluticasone in addition to full dose fostair it does hold off an exacerbation but it can cause insomnia. If you are on max dose fostair it would require your gp to provide you with another steroid inhaler just for as required use to avoid exacerbations

[Matman in reply to mmmp4cj2]

I’ve got a couple of Qvar Inhalers from before I got put on Fostair, so have been experimenting with topping up Inhaled Steroids with them when my symptoms get worse (to try to avoid Oral Steroids). Seems to help, but - unless I figure out a way to replace them once they run out - I won’t be able to sustain this tactic.

[mmmp4cj2 in reply to Matman]

Your asthma consultant may provide you with qvar if you tell them it is reducing the time between exacerbations

[Matman in reply to mmmp4cj2]

Worth a go I guess. Cheers

[Danielmystar]

Hi I also try to avoid steroids by useing my steroid inhaler for a few days or a week first